B-2018-1275 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1275
10200 S DE ANZA BLVD CUPERTINO,CA 95014-3029(369 01 035) TEAMWRKX
CONSTRUCTION INC
SAN JOSG,CA 95126
OWNER'S NAME:Seagate Technology LLC DATE ISSUED:08/06/2018
OWNER'S PHONE: PHONE NOt(
LICENSED CONTRAC7'012'S DECLARATION BUILDING PERMIT IN EO:
License Class 8 Lid.#907598
Contractor TEAMWRKX CONSTRUCTION INC Dale 12131/2019 XBLDG—ELECT—PLUMB
I hereby affirm that I nm licensed under the provisions of Chapter 9(commencing —MUCH—RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license Is in fall force and effect. JOB DESCRIPTION:
SEAGATE TECHNOLOGY-T.I.INSTALLATION NEW LIGHTS AND
I hereby affirm under penalty of perjury one of the following two declarations: FINISHED;REMOVAL OF(E)NON BEARING WALLS AND DOORS
L I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
�,.. performance o£the work for which this per is issued.
[have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Fluor Arca: Valuation:$95426.00
APPLICANT('RRTIFICATION
I certify that I have read this application and stale that the above
Information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 36901 035
representatives of this city to enter upon the above mentioned property for
inspection purposes.(We)agree to save Indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the app'cant understa sand will comply with all non-point
source regulation er the Cu no Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Data 08/061201II Issued by:Jasmine Archbold
Date:08/06/2018
OWNER-BUILDER DECL ARATION' -
1 hereby affirm flout I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a.of is
u 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,1 agree to remove all new materials for
compensation,will do the work,and the shmemre is not intended or offered for inspection,
salc(Sec.7044,Business&Professions Code)
z. 1,as owner of the property,sm exclusively contracting with licensed Signature ofApplicane
contractors to construct the project(Sec.7044,Business&Professions Code), Date:08/06/2018
1 hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 have and will maintain a Certificate of Consent to self insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have rend the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California health&Safety Code,Sections 25505,25533,and 25534.1 will
permit
is issued. m aintoin compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. 1 certify that in the performance of the work For which Health this permit is issued,I materi &Safety Code,Section 25532(x)should I store or handle hazardous
al.Additionally,should i use equipment or devices which emit hazm•dous
shall not employ any person in any manner so as to become subject to the air cantamiamts as defined by the Buy Area Air Quality Management District I
Worker's Compensation laws of Califf mis.if,after making this certificate of will maintain compliance with the Cupertino Muralidpajll Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provislous of the the Health&Safety Coit Sec'nos 2550. 533, /d 25�34
Labor Code,I must forthwith comply with such provisions or this permit shall
deemed emed revoked, Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/06/2018
I certify that I have read this application and stale that the above information is CONSTRUCTION
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is Issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes. (We)agree Lender's Name
to save Indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Dale 08Po018
6/2
Professional